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Discuss how the physiotherapist could advise the patient and how the physiotherapist might alter the patients medication within the CMP. Suggest a prescription that the physiotherapist could write for this patient. Apart from the consultant pain physician, who else should be informed of the CMP and prescription. When and by whom should the patient be reviewed. Case study A patient has been receiving abdominal radiotherapy for a period of time for the treatment of colon cancer. She has suffered quite serious nausea as a result of the treatment.

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These effects are not clinically significant except in intolerant individuals, those with idiosyncratic reactions, in cases where absorption into the blood stream is unexpectedly rapid or in those with impaired metabolism andor excretion. Local anaesthetics can pass into the central nervous system through the blood brain barrier. They have the same effect on central nervous tissue as they have on peripheral nervous tissue; that is, they inhibit conduction of nerve impulses. The first effects are tremor and restlessness because inhibitory pathways are affected first. As the dose increases, convulsions may occur. Initially, due to central nervous system effects, the rate of respiration increases.

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All drugs in this group are toxic, common side effects being gastrointestinal disturbances, anorexia, pancreatitis and liver damage. Non-nucleoside reverse transcriptase inhibitors such as efavirenz and nevirapine are similar and have a similar profile of adverse effects. Viral protease is essential in retroviruses for the production of mature viral particles. Inhibition of the enzyme slows spread of virus from cell to cell because immature particles cannot infect host cells. There are now a number of protease inhibitors available; examples are indinavir and amprenavir. Adverse effects of protease inhibitors are similar to those seen with reverse transcriptase inhibitors.

Mrs Cooper is being treated with amantadine for her mild tremor and slowness of movement. While Mrs Cooper is managing quite well at home, her daughter is keen to know if there is anything she should be aware of regarding the treatment for Parkinsons disease. Are there any side effects of amantadine that she should look out for. Mrs Coopers daughter asks you if her mothers condition is likely to get worse, how quickly, and if there is anything else that can be done if it does. What can you tell her about this and is there anything else you could advise the patient and her family about. Case study You are treating Pete, a young man of accident.

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